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Background Elderly onset rheumatoid arthritis (EORA) has several peculiarities. Which activity index should we use in this age group is still an unresolved issue. The use of ESR in DAS28 is widespread, but it is well known that ESR could increase with age, overestimating activity. DAS28-PCR or SDAI, which uses PCR, or CDAI that does not use analytical data, could be more suitable alternatives. Objectives To describe disease activity scores evolution in EORA and to analyse the correlation and concordance between them. Methods Longitudinal observational study in naive treatment EORA patients (ACR/EULAR 2010 criteria). Study visits were carried out basally (pre-treatment) and at month 1, 3, 6 and 12. DAS28 VSG, DAS28 PCR, SDAI and CDAI were calculated at each visit, and ACR/EULAR remission index at 12 months. The same rheumatologist made all visits and explorations. Correlations were analysed using the Spearman or Pearson correlation index (p value ≤ 0.001). The concordance was evaluated with the kappa index. The statistical study was performed with Stata 15.1. Results 45 patients with EORA were enrolled. Table 1 and 2 summarize the clinical and analytical characteristics. All the scores had a very good linear correlation both at baseline and at follow-up (correlation score: 0.83-0.98). A moderate concordance was observed from the baseline visit between DAS28-VSG and DAS28-PCR (k=0.43-0.52, p Conclusion The correlation between the different scores was good. However, the concordance between all the scores decreases as time passes, according to a higher percentage of patients in remission or low activity. This low-moderate concordance is demonstrated even between DAS28-PCR and DAS28-VSG, and when these are compared with CDAI and SDAI. CDAI and SDAI are the only ones that maintain a good concordance between them, even when the number of patients in remission or low activity increases. ACR/EULAR only maintains an acceptable concordance with the most restrictive scores, SDAI and CDAI. By contrast, agreement is very low with DAS28, especially by DAS-PCR. Disclosure of Interests None declared

Background Myositis specific antibodies have gained special importance in last years. Its knowledge has allowed stratifying patients in different clinical phenotypes, predicting with greater accuracy prognosis and establishing a clinical attitude to follow. SAE1/2 antibody (anti-small ubiquitin-like modifier activating enzyme) was first described in 2007 in patients with amyopathic dermatomyositis with cutaneous and digestive involvement. Its prevalence ranges from 8% in European cohorts to 3% in asians. Objectives Describing myositis specific antibodies (MSA) in a cohort of inflammatory myopathies. To characterize the clinical phenotype of SAE1/2 antibody and to compare it with the rest of MSA. Methods Patients diagnosed of dermatomyositis in a tertiary hospital from 1978-2018, according to the criteria of Bohan and Peter (1975) and according to Dalakas classification criteria (2015). Clinical and analytical data, including the immunological profile were collected, as well as the treatments received and the evolution of the disease. Results Out of 46, 41 dermatomyositis had positive antinuclear antibodies (ANA). 55% percent had aNA titles≥640, being the fine speckled pattern the most frequent (43%) followed by coarse speckled and homogeneous (13.6% each). 72% had MSA, the most frequent being antiJo1 (27.3%) followed by MDA5 (18.2%) and SAE1/2 (15%). Up to 40% had two or more antibodies, being the association with antibodies Ro52 and Ro60, the most frequent. 5 patients presented positivity against SAE antibody. In comparison to the rest of MSA, 80% presented with cutaneous debut (p = 0.00), being the most frequent manifestations heliotrope erythema (p = 0.00), Gottron papules (p = 0.10) and skin rash (p = 0.00). 60% had pathological capillaroscopy compared to 15% (p = 0.00). Muscular balance was preserved in 60% of patients. Sixty percent had dysphagia vs 9% (p = 0.00). Two of them had lung involvement (alveolar hemorrhage and rapidly progressive pneumonitis). In comparison with SAE negative group, patients presented more pulmonary hypertension (44.5vs34 mmHg), without reaching significant differences. No significant differences were found between muscle enzyme levels’ neither acute phase reactants. As complications, one patient presented a myocarditis with quickly rapidly progressive pneumonitis that required high doses of corticotherapy and another one alveolar hemorrhage, which was treated the same way. All patients required corticotherapy at doses of mg/kg, requiring two of them to be treated with DMARDs (methotrexate and dolquine) and one of them with immunoglobulins due to cutaneous involvement. Mortality rate was 40% due to rapidly progressive lung affectation and cardiorespiratory arrest. Conclusion Higher prevalence of SAE1/2 antibody in our cohort may be explained due to the use of amplified myositis antibodies kit that specifically includes this antibody. These patients typically present with cutaneous involvement and dysphagia but also lung affectation as a complication. Studies with larger samples should be performed in order to know the prognosis of this antibody specificity. Disclosure of interests None declared

Background Polyarthritis at the elderly people usually has a similar onset with an acute inflammatory character and scapular girdle involvement. Differentiating elderly onset rheumatoid arthritis (EORA) and polymyalgia rheumatica (PMR) can be a diagnostic challenge. Objectives To analyse the clinical and analytical differences between EORA and PMR. Methods Longitudinal observational study of patients older than 60 years newly diagnosed with EORA (ACR/EULAR 2010) and PMR (ACR/EULAR 2012). Inclusion: consecutive and voluntary. Follow-up time: 12 months. A single rheumatologist made all follow-up visits. The clinical-epidemiological and analytical characteristics were collected. The statistical study was performed with Stata 15.1. Results 45 EORA were recruited (53% women; mean age 74.8 ± 7.5) and 20 PRM (85% women; mean age 76.6±5.0). 75% of EORA had scapular girdle involvement, but only 44% of the pelvic girdle. All had peripheral arthritis, and the small joints of the hands were involved in 93.3%, with edema in 46.7%. Forty percent of EORA patients were seropositive (RF> 20 IU/mL and/or ACPA> 20 U/mL): 33% RF positive (132.8 ± 126 IU/mL), 28.9% for ACPA (2 cases [15.4%] from 100 to 250 U/mL and 11 cases [84.6%] above 250 U/mL) and in 10 patients [22.2%] double positive). All patients with PMR patients had shoulder girdle involvement and 90% of the pelvic girdle. None of them had peripheral arthritis. RF was positive in one patient (73 IU/mL) and ACPA in 2 patients (titers between 20-40 U/mL). No patient was double positive. Table 1 and 2. After 12 months of follow-up, there was no difference between the dose of glucocorticoids received in patients with EORA and PMR (p = 0.684). There were also no differences in glucocorticoids adverse effects according to the diagnosis (p = 0.734). Regarding the use of immunosuppressors, this was higher in patients with EORA (91% EORA and 20% PMR), according to the usual clinical practice guidelines. The percentage of remission in PMR at 12 months was 95%. However, using DAS 28-VSG, only 40.9% of patients with EORA were in remission at 12 months (p=0.003). Conclusion The female predominance was higher in PMR than in EORA. The scapular girdle involvement, but especially the pelvic girdle, was more frequent in PMR. In contrast, involvement of peripheral joints and edema were more frequent in EORA. RF and ACPA were more frequent in EORA. There were no other analytical differences that would help their differential diagnosis. The mean and accumulated doses of glucocorticoids during the first 12 months were similar, as well as the percentage of side effects. Immunosuppressors are more frequently used in EORA than in PMR. Remission is achieved more commonly in PMR than in EORA. References [1] Olivieri I, Pipitone N, D’ Angelo S, Padula A, Salvarani C. Late-onset rheumatoid arthritis and late-onset spondyloarthritis. Clin Exp Rheumatol 2009;27(4 Suppl 55):S139-145. [2] Pease CT, Haugeberg G, Montague B, Hensor EMA, Bhakta BB, Thomson W, et al. Polymyalgia rheumatica can be distinguished from late onset rheumatoid arthritis at baseline: results of a 5-yr prospective study. Rheumatology 2009;48(2):123-7. Disclosure of Interests None declared

Background Denosumab (Dmab), an anti-receptor activator of nuclear factor kappa-B ligand (RANKL) monoclonal antibody, has been shown to increase bone mineral density (BMD) at lumbar spine and proximal femur up to 21.6% and 9.1% respectively at 10 years of treatment. Additionally, Dmab has shown a marked decrease of vertebral, nonvertebral and femoral fractures during treatment. Nowadays, the existence of inadequate response to Dmab treatment remains unknown. Objectives: to describe the clinical, analytical and densitometric characteristics of patients with an inadequate response (IR) to Dmab treatment. IR was defined as the presence of a new fragility fracture during Dmab treatment or a significant decrease in BMD (≥5% at lumbar spine or ≥4% at proximal femur) within at least 12 months of therapy. Methods: retrospective study including patients with osteoporosis with an IR to Dmab. Therapeutic compliance was checked by clinical anamnesis and the electronic prescription. Risk factors for osteoporosis, history of fragility fractures, previous anti-osteoporotic treatment, densitometric and analytical data were collected before and at the moment when IR was diagnosed. Results Fourteen patients were included (12 women and 2 men) with mean age of 75 ± 9 years. The causes of osteoporosis were: postmenopausal (n=8, 57.14%), induced by glucocorticoids (n=3, 21.43%), alcoholic (n = 1, 7.14%) and multifactorial (n=2; 14.28%). Nine patients (64.28%) had been previously treated with oral or intravenous bisphosphonates for a mean of 5.8 ± 2.76 years. Nine patients (64.28%) had previous vertebral fractures (median 2, range 1-8), 2 of them had also presented a femoral fracture. During Dmab treatment, 7 patients (50%) presented a decrease in BMD (mean loss: proximal femur -3.5%, p=0.09; lumbar spine - 5.8%, p=0.046;) and 7 had incidental fractures: 5 vertebral (median 1, range 1-4), 1 humerus and 1 femur. The duration of treatment with Dmab was 3.82 ± 1.85 years in patients who sustained fragility fractures and 2.39 ± 1.4 years in patients with a BMD decrease. A multiple myeloma was diagnosed in a patient with vertebral fractures during Dmab treatment. After The identification of Dmab RI most patients mantained same treatment. Of the patients with incidental fragility fractures, 2 started combined treatment with teriparatide and Dmab, 1 changed to teriparatide and 2 maintained the same treatment. Of the 7 patients with BMD only 1 changed to zoledronic acid. Conclusion Most patients with IR to Dmab treatment had previous fragility fractures and had been previously treated with bisphosphonates for a mean duration of 5 years. The patients with a significant decrease in BMD had lesser duration of Dmab treatment than those who sustained fractures during Dmab treatment. Only one patient had a clinical cause for the IR development. Disclosure of Interests None declared

Background Clinical manifestations of systemic lupus erythematosus (SLE) and infections sometimes are difficult to distinguish. In clinical practice low complement and anti(ds)DNA levels are used to assess lupus activity but its determination usually requires some days. Leukocyte count, CRP and ESR cannot discriminate SLE from infectious processes. Calprotectin could be a good biomarker to assess lupus activity since it is more specific than CRP and ESR and faster to analyse than anti(ds)DNA. Objectives Our aim is to determine serum calprotectin levels in patients with SLE, and its correlation with analytical and clinical manifestations, especially with disease activity. Methods A total of 148 patients were included. All patients included fulfilled the SLE criteria (SLICC 2012). A quantitative ELISA analysis was performed to assess levels of serum calprotectin (CALPRO AS, Norway). Other biomarkers of lupus disease activity were also assessed (levels of anti(ds)DNA, hypocomplementemia, ESR and CRP). Clinical variables and activity/damage index (SLEDAI/SLICC) were also evaluated. The study was approved by the Clinical Research Ethics Committee of the hospital and all patients signed an informed consent. The results were compared with a healthy control group of similar age and sex (n=20). Results 134 patients (92%) were women with a mean age of 46±12 years and an average SLE evolution of 12±7 years. Mean SLEDAI was 2±2 (105 inactive [ 13]). Mean SLICC was 0.31±0.70. No significant differences were observed in serum calprotectin levels between patients with SLE and healthy controls (2.93±2.35 vs 2.17±1.49 µg/mL, p=0.160). Calprotectin was positively correlated with CRP (r=0.447, p= 100UI/mL) had higher calprotectin compared to patients with lower anti(ds)DNA (3.20±2.63 vs 2.42±1.57 µg/mL; p=0.027), however this pattern was not observed with hypocomplementemia. Contrary to what we expected, we did not observe significant differences on calprotectin levels depending on SLEDAI index classification (cutoff at 4 and 12). Moreover, no differences were observed on calprotectin levels between those patients with/without clinical manifestations such as serositis, arthritis or glomeruloneprhitis. Patients with antiphospholipid antibodies had higher calprotectin levels (3.75±2.04 vs 2.77±2.38 µg/mL;p=0.045). Conclusion Serum calprotectin levels were positively correlated with CRP levels and leukocyte count. Patients with higher anti(ds)DNA levels had higher calprotectin levels, however we did not observe significant differences depending on SLEDAI index or the presence of arthritis, serositis neither glomerulonephritis. Even that calprotectin determination is faster than anti(ds)DNA levels and could be helpful in assessing inflammatory activity. There is an interesting relation between antiphospholipid antibodies and calprotectin. This study should be continued in a larger sample of active SLE patients to assess its utility in clinical practice as a discriminating biomarker for flares and even infection Disclosure of Interests None declared

Background: Dermatomyositis (DM) is an idiopathic inflammatory myopathy. The recent years has increased its knowledge thanks to best characterization of myositis-specific antibodies that correlate with different clinical phenotypes.with different clinical phenotypes. Objectives: To describe the clinical and analytical features of a series of dermatomyositis: clinical debut, clinical manifestations as well as the treatments received and the evolution of the disease. Methods: Patients diagnosed of dermatomyositis in a tertiary hospital between the years 1978-2018 according to the criteria of Bohan and Peter (1975) and according to Dalakas’ classification criteria (2015). Clinical, analytical and immunological profile data were collected, as well as treatments received and the evolution of the disease. Results: A total of 59 inflammatory myopathies diagnosed between the years 1985 and 2018 were included. 46 were dermatomyositis (78%), 9 polymyositis (15%) and 4 necrotizing myositis (7%). 69% were women and 22% were smokers. Clinic started at 54 ± 17 years. The initial manifestation was pulmonary in 26.7% followed by cutaneous manifestations (24.4%) and the muscular (22.2%), while a 17.8% started skin and muscular manifestations at the same time. 45.5% behaved like a myopathic DM while a 28% as amyopathic DM and antisynthetase syndrome respectively. 38% presented interstitial involvement being the most common non-specific interstitial pneumonitis (76%)followed by usual interstitial pneumonitis (17%). In these patients, DLCO was decreased (mean of 58.9% and 13.2) as well as the FVC (average of 58%, 2.5L). 73.3% presented cutaneous involvement being the most common manifestations the Gottron papules (37.8%) and the heliotrope rash (35.6%), and up to 27% had cuticular affectacion. 64% had muscle involvement, afecting proximal and symmetrical. Neck flexors were affected in a 38% of patients while 20% had dysphagia.Only 3 patients presented dysphonia (7%) and 2 myocarditis Analytical data Conclusion: 80% received corticotherapy at a dose of mg/kg/day and 20% required high doses of metilprednisolone due to muscular involvement or pulmonary. 18% immunoglobulins and 11% cyclophosphamide. As maintenance 80% received disease modifiying antirheumatic drug in addition to corticosteroid therapy in descending doses (azathioprine 22%, dolquine 15%, tacrolimus 13.3%, rituximab 11%) due to muscle (29.9%), cutaneous (24.4%) and pulmonary involvement (22.2%). As complications, 2 cases of the syndrome were registered hemophagocytic Virtually all patients they presented pulmonary hypertension (mean 34 ± 12 mmHg). 5 patients (11.1%) were diagnosed with neoplasia, two of them after the diagnosis of DM. The mortality was 24%. 3 patients died due to a rapidly progressive pneumonitis, another 2 due to alveolar hemorrhage and three of them due to complication of the neoplastic disease. Dermatomyositis occurs in a variable way, with predominance of pulmonary, skin and muscle manifestations. They require corticotherapy and immunosuppressive treatment for maintenance, even so, mortality is high. Disclosure of interests: None declared

Background Extra-articular manifestations (EAM) in rheumatoid arthritis (RA) are more prevalent in patients with seropositive, nodular and long term disease. Around 40% of patients with RA can develop EAM, although the incidence has decreased with the “treat to target” strategy. Objectives To describe EAM in a cohort of patients with rheumatoid arthritis. Methods Retrospective descriptive study of patients diagnosed with RA between 2000 and 2018 who are currently under active biological treatment. Cardiovascular risk factors, baseline characteristics of RA and EAM during their evolution are collected. Statistical analysis is performed with SPSS 24. Results We recruited 108 patients, 81.5% female, with mean age at onset of RA of 50 ±15 years (range 17-82). RF was positive in 84.3% and ACPA in 81.3%. Erosions were observed on hands or feet at diagnosis in 35.2%. Mean follow up period: 12±8 years. The most common initial treatment was methotrexate (82.4%) and 44.4% received other DMARDs: leflunomide (32.3%), hydroxychloroquine (16.2%) and others (9.1%). DAS28VSG at diagnosis was 4.15±1.18 (1.89-6.02) and at the introduction of the first biological drug it was 5.02 ±1.16 (mean years since diagnosis 6±5). The first biological drug was etarnecept (40.7%), followed by adalimumab (17.6%), abatacept (15.7%), rituximab (7.4%), tocilizumab (7.4%) and infliximab (4.6%). 57.4% discontinued the first biologic: secondary failure (58.1%) or adverse effects (20.6%). 65.7% (71 patients) developed some EAM during disease evolution and 14.8% appeared during the first year. During this first year, secondary Sjogren (37.5%) was the most frequent, followed by rheumatoid nodules (18.7%), EPID (18.7%) and osteoporosis (18.7%). Two or more EAMs were present in 33.3% of patients. Fifty-four patients (56.3%) did not present any EAM at the beginning of the biological treatment and 29.6% (21 patients) developed EAM afterwards, with an average of 1±3 years. Pulmonary involvement was the first EAM to appear after the onset of biological treatment, followed by anemia (both in the first year). Summarizing the data of all patients over time, the most frequent EAMs were: osteoporosis (28.7%, mean appearance: 5 years from diagnosis); secondary Sjogren syndrome (27.8%, mean 6 years); normochromic normochromic anemia (21.3%, mean 8 years) and pulmonary involvement (17.6%, mean 4 years), presented as EPID (63.3%), NINE (25%), NIU (8.3%) and pulmonary nodules (8.3%). Other EAM observed were: cutaneous involvement in the form of rheumatoid nodules (15.7%, mean 5 years); ophthalmological involvement (6.5%, mean 18 years) (PUK 2.8%, uveitis 1.9%, scleritis 0.9%, episcleritis 0.9%); amyloidosis (3.7%, mean 16 years) and vasculitis (2.4%, mean 14 years). Conclusion EAM have a high prevalence in RA patients receiving biologic treatment (76.6%). A third part of patients had 2 or more EAMs. 14.8% develop the first EAM during the first year of evolution of RA and 30% in the first 5 years. The most frequent are osteoporosis and Sjogren’s syndrome, according to what is described in the literature. Pulmonary involvement is the most rapid during the evolution of RA with an average of 4 years. References [1] Marcucci E, Bartoloni E, Alunno A, Leone MC, Cafaro G, Luccioli F, et al.Extra-articular rheumatoid arthritis. Reumatismo. 2018Dec20;70(4):212-224 Disclosure of Interests None declared

Background: Ustekinumab (UST) is an anti- interleukin (IL) 12/23 monoclonal antibody that has been shown to be effective and safe in psoriatic arthritis (PsA) in two phases III clinical trials. However, we have very few UST data in a real- life setting. Objectives: To assess the effectiveness, safety and survival of UST among patients with PsA treated under routine clinical care. Methods: Retrospective and multicentric study. Epidemiological and clinical data were collected through the electronic medical record of all patients with PsA who started UST due to rheumatological indication in 14 hospitals of Catalonia and the Balearic Islands (Spain). Results: 152 patients were included, 116 (76.3%) with 45mg and 36 (23.8%) with 90mg. 55.9% were women, mean age 54.79 (12.5) years, and mean disease duration 209 months. 132 patients (87%) had oligo (30.3%) or polyarticular involvement (56.6%). 26.8% had enthesitis and 36.2% dactylitis. 48p(35.6%) had erosions. 94p (61.8%) had previously received another biological therapy, and 39 of them (38.8%) had received 2 or more. 54.6% of the patients were taking DMARDs and 39.5% glucocorticoids. The baseline DAS 28 was 3.97 (1.45), C reactive protein (CRP) was 2 mg/dl (2), SJC was 4.0 (5.4), and PASI was 6.5 (8.4). There were no significant differences in clinical and epidemiological data between patients at 45 or 90 mg except in obese patients (58.4% in 90mg vs 40% in 45mg, p = 0.038). Overall, there was a significant decrease in DAS28, SJC, TJC and PASI in the first month of treatment, with more pronounced improvement in skin (PASI and BSA) than in joints outcomes, where the curves reached a plateau at 6 months. There were no significant differences between joint and/or skin outcomes between 45 and 90 mg doses. Patients naive to biological therapy had an earlier skin improvement than patients with previous biological failure. Likewise, the improvement in joint outcomes was also faster in naive vs biological experienced patients (DAS28 and SJC 4m, p = 0.01 and 0.01, respectively). After an average of 19m of follow-up, 94 out of 152p (61.8%) continued with UST, 54.4% started at 45mg and 72.2% at 90mg (p = 0.04). 42p (28.2%) stopped UST due to joint inefficacy, 8p (5.4%) for skin inefficacy and 4 (2.7%) for adverse effect. Although survival was better in patients with fewer previous biological agents, no significant differences were achieved (p = 0.233 for naive and p = 0.072 for patients with 1 biological failure). Conclusion: This analysis demonstrates that UST, administered to PsA patients in a routine clinical care setting, is safe and effective in improving skin and joint outcomes. 61.2% of the patients continued with the treatment after an average of 19m of follow-up. Joint and skin outcomes reached significant differences from the first month. The efficacy seems faster in those patients with fewer lines of previous biological therapies. One third of the patients interrupted the therapy due to joint inefficacy. Acknowledgement: JANSSEN Disclosure of interests: Ana Belen azuaga-Pinango: None declared, Beatriz Frade-Sosa: None declared, ana Laiz Consultant for: Lilly, Novartis, abbVvie, MSD, UCB and Janssen, Speakers bureau: Lilly, Novartis, abvvie, MSD, UCB and Janssen, Paula Estrada: None declared, Luciano Polino: None declared, Emma Beltran: None declared, Agueda Prior-Espanol: None declared, Lourdes Mateo Soria: None declared, Carme Moragues Pastor : None declared, agusti Sellas-Fernandez: None declared, aNA URRUTICOECHEA-ARANA: None declared, Mireia Moreno : None declared, Javier Garcia Miguel: None declared, Jose L Tandaipan: None declared, Manel Pujol: None declared, Vicenc Torrente Segarra : None declared, inmaculada Ros Vilamajo : None declared, Sergi Ordonez : None declared, Delia Reina-Sanz: None declared, andrea Cuervo: None declared, Juan D. Canete: None declared, Julio Ramirez: None declared